Marin gearing up for wave of applicants for health coverage under Obamacare

With just a month to go before Americans can begin signing up for health care coverage under the Affordable Care Act, the rush is on to reach uninsured Marin residents and inform them about their new options.

Marin County's Department of Health and Human Services estimates that 11,500 Marin residents will be eligible for subsidized private health care coverage or Medi-Cal under what has become known as "Obamacare." And an additional 2,000 Marin residents will have the option of switching health care providers and purchasing insurance from one of the five providers participating in the California health care exchange, known as Covered California.

"Obviously, Obamacare went through its ups and downs, including the Supreme Court supporting that it is constitutional. Now we get down to implementation and the details of how it is going to work," said Linda Tavaszi, chief executive of the Marin Community Clinics, a nonprofit that provides medical care for Marin's economically disadvantaged and uninsured population.

Sparkie Spaeth, deputy director of the county Department of Health and Human Services, said eligibility standards for Medi-Cal have been broadened because of Obamacare. Previously, a family of four could earn no more than $23,550 per year, and have virtually no tangible assets, to qualify for Medi-Cal. Under the new rules, the annual income level for a family of four has increased to $31,810, and applicants may own a house and car.

As a result, Spaeth said, an additional 1,800 Marin residents will qualify for Medi-Cal beginning in October. In addition, Spaeth said the county estimates there are another 2,450 Marin residents who already qualify for Medi-Cal who aren't taking advantage of it.

Tavaszi said some or potentially all of those patients are already receiving treatment at Marin Community Clinics.

Spaeth said another 7,250 Marin residents will be eligible to purchase subsidized private insurance through the California health care insurance exchange, Covered California. Five companies have been approved to market plans through the exchange: Anthem Blue Cross, Blue Shield, Kaiser Permanente, Western Health Advantage and HealthNet.

These companies will provide plans that vary by cost and co-pays. Plans with the lowest cost and the highest co-pays will be listed as "Bronze" plans; plans with the highest cost and the lowest co-pays will be referenced as "Platinum" plans. Purchasers who want something that falls somewhere in between will have the option of "Silver" and "Gold" plans.

To qualify for a subsidy, applicants must earn between 138 percent and 400 percent of the federal poverty level, which amounts to an income of between $31,810 and $92,200 for a family of four. Subsidies will vary depending on the applicant's income.

Spaeth estimates that another 2,000 Marin residents who earn too much to qualify for subsidies will have the option of purchasing one of the Covered California plans. Anyone who is currently being offered "affordable" health insurance by their employer is barred from purchasing from the exchange — as are undocumented immigrants.

Spaeth said, "What they mean by affordable is if the premium that you pay through your employer is no greater than 9.5 percent of your gross monthly income. The plans offered by most large companies would be considered affordable."

Participants may begin applying for Medi-Cal and purchasing insurance through Covered California beginning on Oct. 1. Coverage begins Jan. 1. Anyone who doesn't purchase a plan by March 31 will have to wait until October 2015 to participate.

And anyone who remains uninsured after the March 31 deadline will face a $95 penalty this year. The penalty will increase gradually to $695 by 2016.

"It is a mandate," Spaeth said.

Spaeth said the Obamacare mandate for large employers to provide health care coverage has been delayed until next year. Small businesses, with fewer than 50 employees, are not required to provide health care coverage, but under Obamacare they are eligible for tax credits if they do.

Marin's Department of Health and Human Services is working closely with Marin Community Clinics, as well as other Marin health clinics and nonprofits serving low-income residents, to educate people about the looming enrollment period.

"We have trained currently 17 people who are certified educators for the process," said Peggy Dracker, chief operations officer at Marin Community Clinics. "We're also going to be training people to be enrollment counselors as well. We'll have these people in all four of our major clinic sites."

New Medi-Cal applicants will have to be certified by the Department of Health and Human Services, and the department has hired 20 new eligibility workers to accommodate what it expects to be a deluge of applications.

Spaeth said 50 people from Marin have been trained to be certified educators, but she said the county has a dearth of certified enrollers and is looking for volunteers.

"We are really looking for boots on the ground to help residents enroll," Spaeth said.